Basic Information
| Provider Information | |||||||||
| NPI: | 1841455896 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HUNDLEY | ||||||||
| OtherFirstName: | ANN | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 209 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | HIGHLANDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287417623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286924289 | ||||||||
| FaxNumber: | 8284825380 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | HIGHLANDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287417623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284826160 | ||||||||
| FaxNumber: | 8284825380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2008 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036127556 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | 125054725 | IL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 2017-02434 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | F400166748 | 01 | IL | MEDICARE PTAN | OTHER |